U.S. patent application number 14/954557 was filed with the patent office on 2016-03-24 for laryngoscope insertion section.
The applicant listed for this patent is AIRCRAFT MEDICAL LIMITED. Invention is credited to Matthew John Ross MCGRATH, Morgan James WALKER.
Application Number | 20160081542 14/954557 |
Document ID | / |
Family ID | 39865866 |
Filed Date | 2016-03-24 |
United States Patent
Application |
20160081542 |
Kind Code |
A1 |
MCGRATH; Matthew John Ross ;
et al. |
March 24, 2016 |
LARYNGOSCOPE INSERTION SECTION
Abstract
A laryngoscope insertion section comprising a tube guide
including at least an inferior tube guiding member and a superior
tube guiding member, wherein the thickness of the insertion section
in a first region is less than the external diameter of the largest
diameter endotracheal tube in an operating range of endotracheal
tube sizes plus the thickness of the inferior tube guiding member
plus the thickness of the superior tube guiding member. Typically,
the insertion section comprises an elongate member and the tube
guide is lateral of the elongate member. Typically, an endotracheal
tube is retained within the tube guide in flexural tension.
Inventors: |
MCGRATH; Matthew John Ross;
(Edinburgh, GB) ; WALKER; Morgan James;
(Edinburgh, GB) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
AIRCRAFT MEDICAL LIMITED |
Edinburgh |
|
GB |
|
|
Family ID: |
39865866 |
Appl. No.: |
14/954557 |
Filed: |
November 30, 2015 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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14073380 |
Nov 6, 2013 |
9226651 |
|
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14954557 |
|
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12675916 |
Jun 7, 2010 |
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PCT/GB2008/002900 |
Aug 28, 2008 |
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14073380 |
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Current U.S.
Class: |
600/194 |
Current CPC
Class: |
A61B 1/00066 20130101;
A61B 1/267 20130101; A61M 16/0488 20130101 |
International
Class: |
A61B 1/267 20060101
A61B001/267; A61B 1/00 20060101 A61B001/00 |
Foreign Application Data
Date |
Code |
Application Number |
Aug 28, 2007 |
GB |
0716612.7 |
Aug 28, 2007 |
GB |
0716613.5 |
Aug 28, 2007 |
GB |
0716615.0 |
Aug 28, 2007 |
GB |
0716667.1 |
Aug 28, 2007 |
GB |
0716668.9 |
Aug 28, 2007 |
GB |
0716671.3 |
Claims
1. An elongate laryngoscope insertion section having a proximal end
and a distal end for insertion into a patient's oral cavity in use,
the insertion section comprising a tube guide for removably
retaining an endotracheal tube and guiding a retained endotracheal
tube towards a patient's larynx, the tube guide comprising a
plurality of tube guiding members having tube guiding surfaces
which are arranged to contact and thereby guide the inferior or
superior surface of a retained endotracheal tube, the plurality of
tube guiding members comprising at least an inferior tube guiding
member having a tube guiding surface on a superior side thereof for
contacting and thereby guiding the inferior surface of a retained
endotracheal tube, and first and second superior tube guiding
members each of which has a tube guiding surface on an inferior
side thereof for contacting and thereby guiding the superior
surface of a retained endotracheal tube, wherein the second
superior tube guiding member is proximal of the first superior tube
guiding member and the tube guiding surfaces of the first and
second superior tube guiding members are spaced apart, wherein the
tube guide is arranged to leave exposed the inferior surface of a
retained endotracheal tube opposite the tube guiding surface of the
second superior tube guiding member, and wherein the distal end of
the tube guiding surface of the second superior tube guiding member
is spaced apart from and proximal of the proximal end of the tube
guiding surface of the inferior tube guiding member, such that an
endotracheal tube can be introduced into the tube guide between the
proximal end of the tube guiding surface of the inferior tube
guiding member and the distal end of the tube guiding surface of
the second superior tube contacting member at an angle to the
length of the insertion section at the proximal end of the tube
guiding surface of the inferior tube guiding member.
2. An elongate laryngoscope insertion section according to claim 1,
wherein the tube guiding surface of the first superior tube
contacting member extends inferiorly towards its distal end and the
tube guiding surface of the second superior tube contact member
extends superiorly towards its distal end.
3. An elongate laryngoscope insertion section according to claim 1,
wherein, in use, the tube guide contacts the inferior surface of a
retained endotracheal tube intermediate the most proximal and most
distal locations where the tube guide contacts the superior surface
of a retrained endotracheal tube, such that a retained endotracheal
tube exerts a superior force on the tube guide at the most proximal
and most distal locations where the tube guide contacts the
superior surface of a retained endotracheal tube and an inferior
force at the said location where the tube guide contacts the
inferior surface of a retained endotracheal tube.
4. An elongate laryngoscope insertion section according to claim 1,
wherein the tube guide is arranged such that a retained
endotracheal tube can be removed laterally from the tube guide.
5. An elongate laryngoscope insertion section according to claim 1,
wherein the insertion section comprises an elongate member which
extends along the majority of the length of the insertion section,
with the tube guide being arranged to retain an endotracheal tube
laterally of the elongate member.
6. A laryngoscope comprising a handle, and an insertion section
according to claim 1.
7. A laryngoscope according to claim 6, wherein the insertion
section is fixedly attached to the handle.
8. An elongate laryngoscope insertion section according to claim 1,
wherein the tube guide is arranged to receive an endotracheal tube
such that it extends distally and superiorly between the proximal
end of the tube guiding surface of the inferior tube guiding member
and the distal end of the tube guiding surface of the second
superior tube guiding member.
9. An elongate laryngoscope insertion section according to claim 1,
wherein the tube guide is arranged so that a retained endotracheal
tube is continuously curved from the most proximal location where
the tube guide contacts the superior surface of a retained
endotracheal tube to the most distal location where the tube guide
contacts the superior surface of a retained endotracheal tube.
10. An elongate laryngoscope insertion section according to claim
9, wherein said curvature is constant.
11. An elongate laryngoscope insertion section according to claim
1, wherein the tube guiding surface of the inferior tube guiding
member is entirely proximal of the tube guiding surface of the
first superior tube guiding member.
12. An elongate laryngoscope insertion section according to claim
1, wherein the insertion section is arranged such that a retained
endotracheal tube remains exposed along an entire lateral side.
13. An elongate laryngoscope insertion section according to claim
1, wherein the insertion section comprises a curved portion such
that the inferior surface of the insertion section is incurvate and
the superior surface of the insertion section is excurvate and the
first superior tube guiding member is located sufficiently distally
of the first region to guide a retained tube at an angle of at
least 20.degree. to an angle at which a retained tube is guided at
the proximal end of the insertion section.
14. An elongate laryngoscope insertion section having a proximal
end and a distal end for insertion into a patient's oral cavity in
use, the insertion section comprising a tube guide for removably
retaining an endotracheal tube and guiding a retained endotracheal
tube towards a patient's larynx and an elongate member, wherein the
tube guide comprises a plurality of tube guiding members which
extend laterally of the elongate member and have tube guiding
surfaces which are arranged to contact and thereby guide the
inferior or superior surface of a retained endotracheal tube, the
plurality of tube guiding members comprising at least an inferior
tube guiding member having a tube guiding surface on a superior
side thereof for contacting and thereby guiding the inferior
surface of a retained endotracheal tube, and a first superior tube
guiding member having a tube guiding surface on an inferior side
thereof for contacting and thereby guiding the superior surface of
a retained endotracheal tube, wherein there is at least one
location, proximal of the first superior tube guiding member, where
an endotracheal tube is retained in use laterally of the elongate
member with the inferior and superior sides of the endotracheal
tube being left exposed.
15. An elongate laryngoscope insertion section according to claim
14, wherein no tube guiding member is provided at the said
location.
16. An elongate laryngoscope insertion section according to claim
14, wherein the said location is intermediate the first superior
tube guiding member and a second superior tube guiding member.
17. A laryngoscope comprising a handle, and an insertion section
according to claim 14.
18. A laryngoscope according to claim 17, wherein the insertion
section is fixedly attached to the handle.
19. An elongate laryngoscope insertion section according to claim
14, wherein the tube guide is arranged so that a retained
endotracheal tube is continuously curved from the most proximal
location where the tube guide contacts the superior surface of a
retained endotracheal tube to the most distal location where the
tube guide contacts the superior surface of a retained endotracheal
tube.
20. An elongate laryngoscope insertion section according to claim
14, wherein said curvature is constant.
21. An elongate laryngoscope insertion section according to claim
14, wherein the insertion section is arranged such that a retained
endotracheal tube is retained with its lateral side at least
partially exposed along the entire length of the insertion
section.
22. An elongate laryngoscope insertion section according to claim
14, further comprising a second superior tube guiding member, which
is proximal of the first superior tube guiding member, and said
location is intermediate the first and second superior tube guiding
members.
23. An elongate laryngoscope insertion section having a proximal
end and a distal end for insertion into a patient's oral cavity in
use, the insertion section comprising an elongate member which
extends along the majority of the length of the insertion section
and a tube guide for removably retaining an endotracheal tube
laterally of the elongate member and guiding a retained
endotracheal tube towards a patient's larynx, wherein the insertion
section and tube guide are arranged to leave the inferior or
superior surface of a retained endotracheal tube exposed along at
least 25% of the length of the insertion section between the most
proximal location where the insertion section contacts a retained
endotracheal tube and the most distal location where the insertion
section contacts a retained endotracheal tube.
24. An elongate laryngoscope insertion section according to claim
23, wherein the inferior surface of a retained endotracheal tube is
left exposed along at least 50% of the length of the insertion
section between the most proximal location where the insertion
section contacts a retained endotracheal tube and the most distal
location where the insertion section contacts a retained
endotracheal tube.
25. An elongate laryngoscope insertion section according to claims
23, wherein the superior surface of a retained endotracheal tube is
left exposed along at least 25% of the length of the insertion
section between the most proximal location where the insertion
section contacts a retained endotracheal tube and the most distal
location where the insertion section contacts a retained
endotracheal tube.
26. An elongate laryngoscope insertion section according to claim
23, wherein the superior surface of a retained endotracheal tube is
left exposed along at least 50% of the length of the insertion
section between the most proximal location where the insertion
section contacts a retained endotracheal tube and the most distal
location where the insertion section contacts a retained
endotracheal tube.
27. An elongate insertion section according to claim 23, wherein
both the inferior and superior surface of a retained endotracheal
tube are left exposed along a continuous region of at least 5% of
the length of the insertion section between the most proximal
location where the insertion section contacts a retained
endotracheal tube and the most distal location where the insertion
section contacts a retained endotracheal tube.
28. An elongate insertion section according to claim 23, wherein
the continuous region is located close to the teeth of a patient of
typical dimensions when the insertion section is inserted fully
into a patient in use.
29. An elongate insertion section according to claim 23, wherein
the tube guide is arranged to enable a retained endotracheal tube
to be removed laterally from the tube guide and a retained
endotracheal tube is retained with its lateral side at least
partially exposed along the entire length of the insertion
section.
30. An elongate insertion section according to claim 23, wherein
the tube guide comprises a plurality of tube guiding members which
extend laterally of the elongate member and have tube guiding
surfaces which are arranged to contact and thereby guide the
inferior or superior surface of a retained endotracheal tube, the
plurality of tube guiding members comprising at least a first
superior tube guiding member having a tube guiding surface on an
inferior side thereof for contacting and thereby guiding the
superior surface of a retained endotracheal tube and a second
superior tube guiding member having a tube guiding surface on an
inferior side thereof for contacting and thereby guiding the
superior surface of a retained endotracheal tube, wherein the
second superior tube guiding member is located proximally of the
first superior tube guiding member and the tube guiding surfaces of
the first and second superior tube guiding members are spaced
apart, wherein the tube guiding surface of the second superior tube
guiding member is the most proximal location where the insertion
section contacts a retained endotracheal tube.
31. An elongate insertion section according to claim 30, wherein
the tube guiding surface of the first superior tube guiding member
is the most distal location where the insertion section contacts
the superior side of a retained endotracheal tube and the tube
guiding surface of the first superior tube guiding member is the
most distal location where the insertion section contacts a
retained endotracheal tube.
32. A laryngoscope comprising a handle, and an insertion section
according to claim 1.
33. A laryngoscope according to claim 32, wherein the insertion
section is fixedly attached to the handle.
34. An elongate laryngoscope insertion section according to claim
23, wherein the tube guide is arranged so that a retained
endotracheal tube is continuously curved from the most proximal
location where the tube guide contacts the superior surface of a
retained endotracheal tube to the most distal location where the
tube guide contacts the superior surface of a retained endotracheal
tube.
35. An elongate laryngoscope insertion section according to claim
34, wherein said curvature is constant.
Description
RELATED APPLICATIONS
[0001] This application is a continuation of U.S. patent
application Ser. No. 14/073,380, filed Nov. 6, 2013, which is a
divisional of U.S. patent application Ser. No. 12/675,916, filed
Jun. 7, 2010, which is the U.S. National Phase of International
Application No. PCT/GB2008/002900, filed Aug. 28, 2008, which
designated the U.S. and claims priority to Great Britain
Application Nos. 0716671.3, filed Aug. 28, 2007, 0716612.7, filed
Aug. 28, 2007, 0716613.5, filed Aug. 28, 2007, 0716615.0, filed
Aug. 28, 2007, 0716667.1, filed Aug. 28, 2007 and 0716668.9, filed
Aug. 28, 2007, the entire contents of each of which are hereby
incorporated by reference.
FIELD OF THE INVENTION
[0002] The invention relates to the field of laryngoscope insertion
sections which include a tube guide for detachably retaining an
endotracheal tube and guiding a retained endotracheal tube towards
a patient's larynx.
BACKGROUND TO THE INVENTION
[0003] Laryngoscopes comprise insertion sections, which are the
elongate part of a laryngoscope which extends towards and into a
patient's oral cavity during intubation. Insertion sections may be
removably attachable to a laryngoscope body, integral parts of
laryngoscopes or themselves function as laryngoscopes. As well as
an insertion section, laryngoscopes typically comprises a handle
which is usually elongate and which may be arranged at an angle to
the proximal end of the insertion section or generally parallel to
the proximal end of the insertion section, or at any angle
therebetween. Some known laryngoscope insertion sections, such as
Miller or Wisconsin insertion sections, are substantially flat.
However, the insertion section of a laryngoscope is more commonly
bent to better enter through a patient's oropharynx towards their
larynx. Some known insertion sections include first and second
straight portions, with a bend therebetween, or are curved, at
least in part. Within this specification and the appended claims,
the inferior surface is the surface of an insertion section which
faces the patient's tongue in use.
[0004] The opposite surface is referred to as the superior surface.
Words such as inferior, inferiorly, superior and superiorly are
used in corresponding senses. A superior-inferior axis is a virtual
axis extending parallel to the superior and inferior directions.
The words distal and distally refer to being towards the end of the
insertion section which extends towards a patient's trachea in use
and the words proximal and proximally refer to being towards the
person carrying out intubation in use.
[0005] It is known to provide a laryngoscope insertion section
including a tube guide which extends along the length of the
insertion section. For example, WO 04/073510 (Gandarias) discloses
a laryngoscope insertion section including a tube guide which
extends laterally from an elongate member which contains apparatus
to provide an image of a patient's larynx in use. The tube guide
has inferior and superior walls which extend continuously along the
length of the tube guide. An endotracheal tube may be fitted into
the tube guide and the insertion of the endotracheal tube into a
patient's larynx can be viewed by a user. The endotracheal tube can
then be detached from the insertion section whilst the insertion
section remains within a patient and the insertion section can be
removed, leaving the endotracheal tube in place.
[0006] Tube guides can facilitate intubation by ensuring that, once
an insertion section is in place and the patient's larynx sighted,
an endotracheal tube is already in the correct location to be
pushed forward and inserted into a patient's larynx. However, a
potential disadvantage is that tube guides increase the bulk of the
insertion section. Accordingly, the present invention aims to
provide an insertion section with a tube guide in which the
insertion section is adapted to reduce its bulk, to facilitate
introduction of the insertion section into a patient with an
endotracheal tube in place within the tube guide.
[0007] Another problem with known insertion sections with tube
guides is that they are typically designed for use with
endotracheal tubes of a limited range of sizes. Some aspects of the
present invention are directed to providing insertion sections
adapted to guide a wider operating range of endotracheal tube sizes
than known insertion sections with tube guides.
[0008] Furthermore, the laryngoscope disclosed in WO 04/073510 has
a generally J-shaped insertion section which retains an
endotracheal tube in a generally J-shaped configuration. This has
two significant disadvantages. Firstly, the insertion of a J-shaped
insertion section into a patient's oral cavity can be difficult. A
J-shaped insertion section must be tilted backwards and forwards
during insertion to insert the distal end, manipulate the patient's
anatomy and obtain a good view of the patient's larynx. It is
preferable to provide a laryngoscope which can be more readily
inserted. Secondly, this arrangement means that, when the
endotracheal tube is pushed forward to advance the tube, a
resistive force is developed on the superior side of the tube guide
where the endotracheal tube bends from being substantially straight
to curved, which increases friction. Some embodiments of the
present invention aim to provide an insertion section which is
easier to insert into a patient and/or which has a tube guide along
which an endotracheal tube can be more readily advanced.
[0009] Some aspects of the present invention aim to provide an
insertion section having a tube guide which is easier to operate,
for example because less force is required, than with known
insertion sections with tube guides, or to provide improved
adjustability.
SUMMARY OF THE INVENTION
[0010] According to a first aspect of the present invention there
is provided an elongate laryngoscope insertion section having a
proximal end and a distal end for insertion into a patient's oral
cavity in use, the insertion section comprising a tube guide for
removably retaining an endotracheal tube and guiding a retained
endotracheal tube towards a patient's larynx, the tube guide
comprising a plurality of tube guiding members having tube guiding
surfaces which are arranged to contact and thereby guide the
inferior or superior surface of a retained endotracheal tube, the
plurality of tube guiding members comprising at least an inferior
tube guiding member having a tube guiding surface on a superior
side thereof for contacting and thereby guiding the inferior
surface of a retained endotracheal tube, and a first superior tube
guiding member having a tube guiding surface on an inferior side
thereof for contacting and thereby guiding the superior surface of
a retained endotracheal tube, wherein the insertion section
comprises a first region, which is proximal of the tube guiding
surface of the first superior tube guiding member, where the
thickness of the insertion section is less than the sum of the
external diameter of the largest external diameter endotracheal
tube in an operating range of endotracheal tube sizes plus the mean
thickness of the inferior tube guiding member plus the mean
thickness of the first superior tube guiding member.
[0011] Accordingly, at least in the first region, the insertion
section is narrower than would be the case if it had tube guiding
walls which extended both inferiorly and superiorly of a retained
endotracheal tube in use, which walls ran continuously along the
length of the insertion section.
[0012] By the thickness of an insertion section, we refer to width
or the displacement, parallel to a superior-inferior axis, from the
most inferior point on the inferior side of the insertion section
to the most superior point on the superior side of the insertion
section, through a given cross-section orthogonal to the length of
the insertion section. Words such as "thick", "thicker", "narrow",
and "narrower" should be construed accordingly. By the mean
thickness of a tube guiding member we refer to the mean distance
from the inferior side to the superior side where the tube guiding
surface of the tube guiding member is most inferior or most
superior, as appropriate, along the length of the tube guiding
surface of the tube guiding member. We do not intend that the
thickness of any parts of tube guiding members which do not contact
and thereby guide the inferior or superior surface of retained
endotracheal tubes are taken into account when assessing the mean
thickness of a tube guiding member as any such part is not subject
to the same strength requirements as the parts which contact and
thereby guide the inferior or superior surface of retained
endotracheal tubes and it is these strength requirements which
typically determine the minimum thickness of a tube guiding member.
The tube guiding surfaces of the or each superior tube guiding
member may extend along the length of, or along part of the length
of, the or each superior tube guiding member. The tube guiding
surface of the inferior tube guiding member may extend along the
length of, or part of the length of, the inferior tube guiding
member.
[0013] Preferably, the insertion section is configured such that,
in the first region, the combined thickness of the insertion
section and a retained endotracheal tube having the largest
external diameter in the operating range of endotracheal tube
sizes, is less than the sum of the external diameter of the largest
external diameter endotracheal tube in the operating range of
endotracheal tube sizes plus the mean thickness of the inferior
tube guiding member plus the mean thickness of the first superior
tube guiding member. At least a part of, and optionally all of, the
tube guiding surface of the first superior tube guiding member may
be opposite at least a part of the tube guiding surface of the
inferior tube guiding member. Alternatively, the tube guiding
surface of the first superior tube guiding member and the tube
guiding surface of the inferior tube guiding member may not be
opposite each other.
[0014] By providing an elongate laryngoscope insertion section
having a first region which has a thickness that is less than the
sum of the external diameter of the largest external diameter
endotracheal tube in an operating range of endotracheal tube sizes
plus the mean thickness of the inferior tube guiding member plus
the mean thickness of the first superior tube guiding member, the
insertion section is narrower at the first region in use than would
be the case if tube guiding members of the same thickness as the
inferior and first superior tube guiding members were provided in
the first region and spaced apart sufficiently to receive an
endotracheal tube having the largest external diameter in an
operating range of endotracheal tubes.
[0015] By the external diameter of the largest external diameter
endotracheal tube in an operating range of endotracheal tube sizes,
we refer to the external diameter of the largest external diameter
endotracheal tubes with which the insertion section can be reliably
used. This will depend on the scale of the insertion section which
will itself depend on the application of the insertion section. An
insertion section for use with adult humans may, for example, be
adapted to be usable reliably with endotracheal tubes with an
external diameter of up to 12.3 mm. Tubes of this external diameter
are referred to as Size 9.0 in the field. The minimum external
diameter may be around 5.5 mm. Where the insertion section is made
from a plastics material, the mean thickness of the inferior and
first superior tube guiding members typically requires to be at
least 0.75 mm (preferably around 1.5 mm) to provide suitable
mechanical strength for internal use. Accordingly, the thickness of
the first region is preferably less than 15.3 mm, more preferably
less than 14.6 mm, 13.8 mm or more preferably less than 13.1 mm, in
the case of an insertion section for inserting endotracheal tubes
into adult humans.
[0016] The dimensions of an insertion section for use with infant
humans, including new born infants, are typically scaled
proportionately from the dimensions of an insertion section for use
with human adults. Nevertheless, the proportions of some features,
such as the thickness of the tube guiding members, may not scale
proportionately. In the case of an insertion section for inserting
endotracheal tubes into infant humans, including new born infants,
the operating range of external tube diameters may be 1.0 to 5.0
mm, and the thickness of the first region is preferably less than
8.0 mm, preferably less than 7.0 mm, or more preferably less than
6.0 mm.
[0017] The thickness of the insertion section at the first region
may be less than the external diameter of the largest diameter
endotracheal tube in the operating range of endotracheal tube
sizes.
[0018] The first region may extend from the proximal end of the
insertion section to the proximal end of the tube guiding surface
of the first superior tube contacting member. The first region may
extend from the proximal end of the insertion section to the
proximal end of the first superior tube contacting member. The
first region may include part of the proximal half of the insertion
section but not extend to the proximal end of the insertion
section. The first region preferably comprises a region of the
insertion section which is close to a patient's teeth when the
insertion section is fully inserted into a patient, as this can
reduce the risk of damage to a patient's teeth.
[0019] The insertion section is typically curved such that at least
a portion of the superior surface is excurvate and at least a
portion of the inferior surface is incurvate. The first superior
tube guiding member is typically provided towards the distal end of
the insertion section. Preferably, the first superior tube guiding
member is provided close to, but not at, the distal end of the
insertion section. Typically, the first superior tube guiding
member guides a retained endotracheal tube towards a patient's
larynx. Typically, the tube guiding surface of the first superior
tube guiding member and the tube guiding surface of the inferior
tube guiding member together guide a retained endotracheal tube
towards a patient's trachea in use.
[0020] Typically, the tube guiding surface of the first superior
tube guiding member is the most distal location where the insertion
section contacts the superior surface of a retained endotracheal
tube. Typically, the tube guiding surface of the inferior tube
guiding member is the most distal location where the insertion
section contacts the inferior surface of a retained endotracheal
tube for endotracheal tubes of a range of external diameters
(typically at the upper end of the operating range of endotracheal
tube sizes). The insertion section may be configured such that
endotracheal tubes at the lower end of the operating range of
endotracheal tube sizes do not contact the inferior tube guiding
member opposite the first superior tube guiding member but
endotracheal tubes at the upper end of the operating range of
endotracheal tube sizes do contact the inferior tube guiding member
opposite the first superior tube guiding member.
[0021] Preferably, the tube guide is arranged to guide a retained
endotracheal tube such that the inferior surface of a retained
endotracheal tube is inferior of the superior surface of the
insertion section and the superior surface of a retained
endotracheal tube is superior of the inferior surface of a retained
endotracheal tube at least in the first region and typically from
where the insertion section extends between a patient's teeth in
use and the first superior tube guiding member. This arrangement
fits better with the general shape of the oral cavity than devices
where the endotracheal tube is retained entirely inferiorly or
entirely superiorly of the insertion section at a corresponding
region.
[0022] The insertion section typically comprises a curved portion
(for example, the insertion section may be entirely curved) such
that the inferior surface of the insertion section is incurvate and
the superior surface of the insertion section is excurvate. The
first superior tube guiding member is located sufficient distally
of the first region to guide a retained tube at an angle of at
least 20.degree., and preferably at least 30.degree. to the angle
at which a retained tube is guided in the first region. The first
superior tube guiding member is preferably arranged to guide an
endotracheal tube towards a patient's larynx when the insertion
section is fully inserted in use.
[0023] The first region of the insertion section which has a
thickness which is less than the sum of the external diameter of
the largest external diameter endotracheal tube in an operating
range of endotracheal tube sizes plus the mean thickness of the
inferior tube guiding member plus the mean thickness of the first
superior tube guiding member preferably extends along at least 1 cm
of the length of the insertion section. More preferably, the first
region extends along at least 1.5 cm, and more preferably at least
2.5 cm, of the length of the insertion section which is close to a
patient's teeth in use, to provide a user with an insertion section
which is relatively thin along a significant length of the
insertion section to increase manoeuvrability and reduce the risk
of damage to a patient's teeth.
[0024] The plurality of tube guiding members may further comprise a
second superior tube guiding member having a tube guiding surface
on an inferior side thereof for contacting and thereby guiding the
superior surface of a retained endotracheal tube, wherein the
second superior tube guiding member is proximal of the first
superior tube guiding member and the tube guiding surfaces of the
first and second superior tube guiding members are spaced apart.
Thus, the superior surface of a retained endotracheal tube will
typically be exposed between the first and second superior tube
guiding members.
[0025] In an insertion section for the intubation of human adults,
the tube guiding surfaces of the first and second superior tube
guiding members are typically spaced apart by at least 2 cm, more
preferably at least 4 cm and most preferably at least 6 cm. When
the insertion section is curved, the direction of the insertion
section at the first superior tube guiding member typically differs
by at least 20.degree. and preferably at least 30.degree. from the
direction of the insertion section at the second superior tube
guiding member.
[0026] Preferably, the first superior tube guiding member is
located towards, but not at, the distal end of the insertion
section.
[0027] The second superior tube guiding member may be arranged to
be located close to the teeth of a patient of typical dimensions
when the insertion section is fully inserted into a patient. The
first region may comprise some or all of the second superior tube
guiding member. The second superior tube guiding member may be
located proximal of the teeth of a patient of typical dimensions
when the insertion section is fully inserted into a patient such
that it would not pass into the oral cavity of a patient of typical
dimensions in use.
[0028] Preferably, the insertion section is arranged to leave the
inferior surface of a retained endotracheal tube exposed opposite
the second superior tube guiding member. Typically, no inferior
tube guiding member is provided opposite the second superior tube
guiding member.
[0029] Preferably, the insertion section is arranged to leave the
superior surface of a retained endotracheal tube exposed opposite
at least the proximal end of and optionally all of the inferior
tube guiding member. It may be that no superior tube guiding member
is provided opposite at least the proximal end of and optionally
all of the inferior tube guiding member.
[0030] Thus, at least a region of the insertion section close to a
patient's teeth in use is narrower than would be the case if an
inferior tube guiding member was provided opposite the second
superior tube guiding member and spaced apart from the second tube
guiding member so as to leave a gap therebetween with a thickness
at least equal to the external diameter of the largest endotracheal
tube in an operating range of endotracheal tubes. Preferably, the
distal end of the tube guiding surface of the second superior tube
guiding member and the proximal end of the tube guiding surface of
the inferior tube guiding member are spaced apart along the length
of the insertion section, preferably by at least 0.5 cm, more
preferably by at least 1 cm and most preferably by at least 2 cm.
Preferably also, the distal end of the second tube guiding member
and the proximal end of the inferior tube guiding member are spaced
apart along the length of the insertion section, preferably by at
least 0.5 cm, preferably by at least 1 cm and most preferably by at
least 2 cm.
[0031] Preferably, the component which is parallel to a
superior-inferior axis of the displacement between the distal end
of the tube guiding surface of the second superior tube guiding
member and the proximal end of the tube guiding surface of the
inferior tube guiding member is less than the external diameter of
the largest external diameter endotracheal tube in an operating
range of endotracheal tube sizes. Preferably also, the distance
between the distal end of the second tube guiding member and the
inferior tube guiding member, parallel to a superior-inferior axis,
is less than the external diameter of the largest external diameter
endotracheal tube in an operating range of endotracheal tube
sizes.
[0032] Thus, the tube guide may be arranged to receive an
endotracheal tube other than parallel to the length of the
insertion section, for example, the tube guide may be arranged to
receive an endotracheal tube such that it extends distally and
superiorly between the proximal end of the tube guiding surface of
the inferior tube guiding member and the distal end of the tube
guiding surface of the second superior tube guiding member.
Preferably, the thickness of the insertion section between the
second superior tube guiding member and the first tube guiding
member is less than the thickness of the insertion section at one
and preferably both of the first and second superior tube guiding
members.
[0033] Preferably, the tube guide is arranged such that, for
endotracheal tubes of a range of external diameters (typically
including endotracheal tubes having the largest external diameter
in an operating range of endotracheal tube sizes) a retained
endotracheal tube will not be retained parallel to the length of
the insertion section but have a different radius of curvature to
the insertion section along at least a portion of the insertion
section (typically from the most proximal location where the
insertion section contacts the superior surface of a retained
endotracheal tube to the most distal location where the insertion
section contacts the superior surface of a retained endotracheal
tube). The tube guide may be arranged such that endotracheal tubes
having an external diameter at the top end of the operating range
of endotracheal tube sizes are retained with a smaller radius of
curvature than the insertion section along at least a portion of
the insertion section (typically from the most proximal location
where the insertion section contacts the superior surface of a
retained endotracheal tube to the most distal location where the
insertion section contacts the superior surface of a retained
endotracheal tube). The tube guide may be arranged such that
endotracheal tubes having an external diameter at the bottom end of
the operating range of endotracheal tube sizes are retained with a
higher radius of curvature than the insertion section along at
least a portion of the insertion section (typically from the most
proximal location where the insertion section contacts the superior
surface of a retained endotracheal tube to the most distal location
where the insertion section contacts the superior surface of a
retained endotracheal tube).
[0034] In particular, the plurality of tube guiding members may
comprise a second superior tube guiding member having a tube
guiding surface which is spaced apart from the tube guiding surface
of the first superior tube guiding member and arranged such that,
for endotracheal tubes of a range of external diameters (typically
including endotracheal tubes having the largest external diameter
in an operating range of endotracheal tube sizes), a retained
endotracheal tube will not be retained parallel to the length of
the insertion section between the first and second superior tube
guiding members.
[0035] The tube guide may be arranged such that, for at least some
endotracheal tubes with an external diameter within an operating
range of external diameters, the superior surface of a said
retained endotracheal tube extends superiorly of the superior
surface of the insertion section (typically the superior surface of
the elongate member, where provided), along at least a portion of
the length of the insertion section, towards the middle of the
insertion section. Typically, the tube guide is arranged such that,
for at least some endotracheal tubes with an external diameter
within an operating range of external diameters, the superior
surface of retained said endotracheal tube extends superiorly of
the superior surface of the insertion section at at least one
location between the first and second superior tube guiding
members, where provided.
[0036] Preferably, the tube guiding members are arranged such that,
for endotracheal tubes having a range of external diameters within
the operating range of endotracheal tube external diameters
(typically at the upper end of the operating range of endotracheal
tube external diameters) a retained endotracheal tube will
typically contact the tube guiding surface of either one of or
preferably both the proximal and distal superior tube guiding
members only at the distal ends of the respective tube guiding
member, when a retained endotracheal tube is at rest, retained
within the tube guide. Endotracheal tubes having a range of
external diameters within the operating range of endotracheal tube
external diameters (typically at the upper end of the operating
range of endotracheal tube external diameters) may only contact the
tube guiding surface of the inferior tube guiding member at the
proximal end of the tube guiding surface, when a retained
endotracheal tube is at rest, retained within the tube guide. This
arrangement reduces friction when the endotracheal tube is
subsequently advanced towards a patient's larynx.
[0037] Preferably, the tube guide is arranged to retain an
endotracheal tube under flexural tension from the most proximal
location where the tube guide contacts the superior surface of a
retained endotracheal tube to the most distal location where the
tube guide contacts the superior surface of a retained endotracheal
tube. This facilitates retention of the endotracheal tube within
the tube guide. Preferably, the tube guide also contacts the
inferior surface of a retained endotracheal tube intermediate the
most proximal and most distal locations where the tube guide
contacts the superior surface of a retained endotracheal tube, such
that a retained endotracheal tube exerts a superior force on the
tube guide at the most proximal and most distal locations where the
tube guide contacts the superior surface of a retained endotracheal
tube and an inferior force at the said location where the tube
guide contacts the inferior surface of a retained endotracheal
tube. The use of at least three points of contact facilitates grip.
The retention of an endotracheal tube under flexural tension is of
particular benefit where the tube guide opens laterally as the
flexural tension increases the friction which opposes lateral
movement of the retained endotracheal tube. Nevertheless, the use
of only three points of contact reduces friction when the
endotracheal tube is advance longitudinally compared to an
arrangement in which a retained endotracheal tube is in contact
with a guide wall along a substantial portion of the tube
guide.
[0038] The tube guiding surface of the first superior tube guiding
member may extend distally and inferiorly (i.e. such that it
extends inferiorly towards the distal end) at an angle to the
insertion section. Similarly, the second superior tube guiding
member, where present, may extend distally and superiorly (i.e.
such that it extends superiorly towards the distal end). This
facilitates the retention of an endotracheal tube in a curved
configuration, under flexural tension.
[0039] The tube guide may be arranged such that, for endotracheal
tubes of a range of external diameters (typically including
endotracheal tubes having the largest external diameter in an
operating range of endotracheal tube sizes), a retained
endotracheal tube is continuously curved from where it extends into
a patient's mouth when it is fully inserted in use to the first
superior tube guiding member. Where a second superior tube guiding
member is provided, the tube guide may be arranged such that, for
endotracheal tubes of a range of external diameters (typically
including endotracheal tubes having the largest external diameter
in an operating range of endotracheal tube sizes), a retained
endotracheal tube is continuously curved from the second superior
tube guiding member to the first superior tube guiding member.
[0040] The curvature may or may not be constant.
[0041] Where the tube guiding surfaces of the first and second
superior tube guiding members are spaced apart such that the
superior surface of a retained endotracheal tube is exposed between
the first and second superior tube guiding members, and the tube
guide is arranged so that for endotracheal tubes of a range of
external diameters (typically including endotracheal tubes having
the largest external diameter in an operating range of endotracheal
tube sizes), said retained endotracheal tubes are continuously
curved from where they extend into a patient's mouth when the
insertion section is fully inserted in use to the first superior
tube guiding member, this enables the insertion section and tube
guide to be used with endotracheal tubes of a wider range of
diameters than would be the case for a tube guide defined by
continuous inferior and superior tube guiding surfaces. Preferably,
the insertion section only includes one or more tube guiding
surfaces which extend to contact and thereby guide the inferior
surface of a retained endotracheal tube distally of a patient's
teeth when the insertion section is fully inserted into a patient.
Accordingly, the tube guide preferably only covers the inferior
surface of a retained endotracheal tube distally of a patient's
teeth when the insertion section is fully inserted into a
patient.
[0042] The tube guiding surface of the inferior tube guiding member
preferably extends proximally of the tube guiding surface of the
first superior tube guiding member. Thus, the inferior surface of a
retained endotracheal tube may be guided proximally of the first
superior tube guiding member without the superior surface of a
retained endotracheal tube being guided along the entire length of
the tube guiding surface of the inferior tube guiding member. This
reduces the overall bulk of the insertion section as a retained
tube can be guided adequately using a first superior tube guiding
member with only a relatively short tube guiding surface and an
inferior tube guiding member with a tube guiding surface which
extends distally of the tube guiding surface of the first superior
tube guiding member. Preferably, the tube guiding surface of the
inferior tube guiding member extends at least 1 cm, preferably at
least 2 cm and most preferably 4 to 5 cm proximally of the tube
guiding surface of the first superior tube guiding member. The tube
guiding surface of the inferior tube guiding member may be entirely
proximal of the tube guiding surface of the first superior tube
guiding member, further reducing bulk.
[0043] Preferably, the tube guide is arranged such that a retained
endotracheal tube can be removed laterally from the tube guide.
This facilitates removal of the endotracheal tube in situ within a
patient. Preferably, the insertion section is arranged such that a
retained endotracheal tube remains exposed along an entire lateral
side (e.g. along the entirety of the most lateral point on the
tube, along the length of the tube). By avoiding covering the
lateral side of a retained endotracheal tube, the overall bulk of
the insertion section is reduced.
[0044] Preferably, the insertion section comprises an elongate
member which extends along the majority of the length of the
insertion section, with the tube guide arranged to retain an
endotracheal tube laterally of the elongate member. The tube
guiding members preferably extend laterally of, and typically from,
the elongate member. The elongate member may comprise imaging
apparatus, such as an imaging device (e.g. a camera) or image
conduction apparatus (such as one or more fibre optic cables or one
or more reflective surfaces) for imaging a patient's laryngeal area
in use. The elongate member may comprise illumination apparatus,
such as a light source, including a bulb or one or more fibre
optical cables through which light may be conducted, for
illuminating a patient's laryngopharynx in use. The elongate member
may conduct one or more cable therein, such as electrical wires
which relay signals from an imaging device and/or provide power to
an imaging device and/or light source, where present.
[0045] The elongate member may define a bore therein, which
typically extends from the proximal end of the elongate member,
which may be a through-bore which is open at both ends or which may
be enclosed at a distal end of the bore. The bore may be configured
to receive imaging apparatus and/or illumination apparatus. The
bore may be configured to receive an elongate insertion section
supporting member which resists flexing of the insertion section.
The bore may be configured to receive an elongate insertion section
supporting member which comprises imaging apparatus and/or
illumination apparatus. Where the bore is enclosed at a distal end,
the elongate member is preferably liquid tight to prevent
contamination of imaging apparatus and/or illumination apparatus
enclosed therein.
[0046] Preferably, at at least one location where the insertion
section comprises a said elongate member with an adjacent tube
guide, the elongate member and tube guide are configured such that
the thickness of the elongate member is less than the thickness of
the adjacent tube guide plus the external diameter of a retained
endotracheal tube having the largest external diameter in the
operating range of endotracheal tube sizes. The said location may
be adjacent to the first superior tube guiding member. The said
location may be adjacent to the inferior tube guiding member. The
said location may be adjacent to the second superior tube guiding
member, where provided.
[0047] Accordingly, by providing an elongate member which is
narrower than the adjacent tube guide, we provide an insertion
section which is less bulky than would be the case if the elongate
member was the same thickness as the tube guide.
[0048] Preferably, at at least one location where the tube guide
comprises a superior tube guiding member, such as the first
superior tube guiding member, or a further tube guiding member
which is proximal of the first superior tube guiding member, where
provided, the superior tube guiding member extends further in a
superior direction than the elongate member, adjacent to the
superior tube guiding member.
[0049] Preferably, at at least one location where the tube guide
comprises an inferior tube guiding member, the inferior tube
guiding member extends further in an inferior direction than the
elongate member, adjacent to the inferior tube guiding member.
[0050] Accordingly, by providing a superior tube guiding member
which extends further in a superior direction than the adjacent
elongate member and/or an inferior tube guiding member which
extends further in a superior direction than the adjacent elongate
member, a less bulky insertion section with a lateral tube guide is
provided than would be the case if the superior tube guiding member
did not extend further in a superior direction than the adjacent
elongate member and/or the inferior tube guiding member did not
extend further in an inferior direction than the adjacent elongate
member.
[0051] Preferably, where the insertion section comprises an
elongate member with an adjacent tube guide arranged to retain an
endotracheal tube laterally of the elongate member, there is at
least one location, proximal of the first superior tube guiding
member, where an endotracheal tube is retained in use laterally of
the elongate member with the inferior and superior sides of the
endotracheal tube being left exposed. Preferably, no tube guiding
member is provided at the location. Where first and second superior
tube guiding members are provided, the said location is typically
intermediate the first and second superior tube guiding
members.
[0052] In the first region, or a portion of the first region, a
retained endotracheal tube at the upper end of the operating range
of endotracheal tube sizes may have both its inferior and superior
surfaces left exposed in use and extend inferiorly and superiorly
of an adjacent section of elongate member. Thus, in the first
region, or a portion of the first region, the thickness of the
insertion section may be less than three-quarters, or preferably
less than half of the external diameter of the largest external
diameter endotracheal tube in an operating range of endotracheal
tube sizes.
[0053] Preferably, the first superior tube guiding member extends
laterally and superiorly from the elongate member, from the
superior surface of the elongate member or from the lateral edge of
the elongate member intermediate the inferior and superior surfaces
of the elongate member. Where a second superior tube guiding member
is provided, the second superior tube guiding member preferably
extends laterally and superiorly from the elongate member, from the
superior surface of the elongate member or from the lateral edge of
the elongate member intermediate the inferior and superior surfaces
of the elongate member.
[0054] The first superior tube guiding member and/or second
superior tube guiding member, where present, typically comprises a
lateral portion which is arranged to extend distally and inferiorly
beyond the midline of a retained endotracheal tube. Thus, the tube
guiding surface of the first superior tube guiding member (and
second superior tube guiding member when present) is typically
incurvate.
[0055] Preferably, the inferior tube guiding member extends
laterally and inferiorly from the elongate member. The inferior
tube guiding member typically comprises a lateral portion which is
arranged to extend distally and superiorly beyond the midline of a
retained endotracheal tube. This, the tube guiding surface of the
inferior tube guiding member is typically incurvate.
[0056] Preferably, the lateral extent of the tube guiding members
from the elongate member exceeds at least 50%, more preferably at
least 60%, or more preferably at least 70% of the diameter of the
largest endotracheal tubes in an operating range of endotracheal
tube sizes in order to extend past the midline of and thereby guide
endotracheal tubes. For example, where the operating range of
endotracheal tube sizes extends up to 12.3 mm, the tube guiding
members preferably extend at least 6.1 mm (more preferably at least
7.3 mm and most preferably at least 8.5 mm) laterally from the
elongate member. Where the operating range of endotracheal tube
sizes extends up to 5.0 mm, the tube guiding members preferably
extend at least 2.5 mm laterally from the elongate member.
[0057] The inferior tube guiding member is preferably continuous
but may alternatively be discontinuous. Where an elongate member is
present, the inferior tube guiding member typically extends from,
or from near, the inferior side of the elongate member. The
inferior surface of the tube guiding member may be level with the
inferior side of the tube guide. The inferior tube guiding member
may extend to the distal end of the insertion section.
[0058] The first superior tube guiding member may comprise two or
more separate portions or be continuous. Where present, the second
superior tube guiding member may comprise two or more separate
portions or be continuous.
[0059] Preferably, the insertion section is arranged so that an
intubater can contact an endotracheal tube retained by the tube
guide within a patient's mouth, in use. This increases the amount
of control which is available to the intubater and may be preferred
by intubaters who have been trained to carry out intubation using
traditional laryngoscopes, who are used to being able to manipulate
the endotracheal tube within the patient's mounth. Where the
insertion section comprises a second superior tube guiding member
having a tube guiding surface which is spaced apart from the tube
guiding surface of the first superior tube guiding member, the
insertion section may be arranged so that an intubater can contact
an endotracheal tube distally of the tube guiding surface of the
section superior tube guiding member. The insertion section may be
arranged to that an intubater can contact one or more of the
inferior or superior surfaces of an endotracheal tube retained
within the tube guide within a patient's mouth, in use (e.g.
distally of the distally of the tube guiding surface of the second
superior tube guiding member, where present). The insertion section
may be arranged to that an intubater can contact a lateral surface
of an endotracheal tube retained within the tube guide within a
patient's mouth, in use (e.g. distally of the distally of the tube
guiding surface of the second superior tube guiding member, where
present). The insertion section may be arranged so that an
intubater can contact opposite inferior and superior surfaces of
the endotracheal tube within a patient's mouth, in use, (e.g.
distally of the distally of the tube guiding surface of the second
superior tube guiding member, where present), to facilitate grip
and enable them to gently pinch the tube.
[0060] Preferably, the insertion section is rigid. Preferably, at
least part of the insertion section is transparent. The insertion
section may be made from a plastics material. The insertion section
may be moulded from a plastics material. The insertion section may
be monolithic. Where the insertion section comprises an elongate
member having a bore, the insertion section may function to protect
optical apparatus within the bore in use. Accordingly, the
insertion section may be disposable.
[0061] The insertion section may be an integral part of a
laryngoscope, which may comprise a handle. The insertion section
may be removably attachable to a laryngoscope, body, which may
comprise a handle. The insertion section may function as a
laryngoscope. Preferably, the insertion section is of suitable size
for use in the intubation of adults. Preferably, the operating
range of endotracheal tube sizes includes endotracheal tubes having
an external diameter of 12.3 mm. The relevance of this size is that
this is the external diameter of what is generally referred to in
the industry as Size 9.0 endotracheal tubes, being one of the
largest sizes in common use. However, tubes of this size are
sufficiently broad to present an engineering challenge if an
insertion section is to be provided with an integral tube guide
which capable of operating reliably with tubes of these size but
does not present an obstruction.
[0062] According to a second aspect of the present invention there
is provided an elongate laryngoscope insertion section having a
proximal end and a distal end for insertion into a patient's oral
cavity in use, the insertion section comprising a tube guide for
removably retaining an endotracheal tube and guiding a retained
endotracheal tube towards a patient's larynx, the tube guide
comprising a plurality of tube guiding members having tube guiding
surfaces which are arranged to contact and thereby guide the
inferior or superior surface of a retained endotracheal tube, the
plurality of tube guiding members comprising at least an inferior
tube guiding member having a tube guiding surface on a superior
side thereof for contacting and thereby guiding the inferior
surface of a retained endotracheal tube, and first and second
superior tube guiding members each of which has a tube guiding
surface on an inferior side thereof for contacting and thereby
guiding the superior surface of a retained endotracheal tube,
wherein the second superior tube guiding member is proximal of the
first superior tube guiding member and the tube guiding surfaces of
the first and second superior tube guiding members are spaced
apart, wherein the tube guide is arranged to leave exposed the
inferior surface of a retained endotracheal tube opposite the tube
guiding surface of the second superior tube guiding member.
[0063] According to a third aspect of the present invention there
is provided an elongate laryngoscope insertion section having a
proximal end and a distal end for insertion into a patient's oral
cavity in use, the insertion section comprising a tube guide for
removably retaining an endotracheal tube and guiding a retained
endotracheal tube towards a patient's larynx, the tube guide
comprising a plurality of tube guiding members having tube guiding
surfaces which are arranged to contact and thereby guide the
inferior or superior surface of a retained endotracheal tube, the
plurality of tube guiding members comprising at least an inferior
tube guiding member having a tube guiding surface on a superior
side thereof for contacting and thereby guiding the inferior
surface of a retained endotracheal tube, and a first superior tube
guiding member having a tube guiding surface on an inferior side
thereof for contacting and thereby guiding the superior surface of
a retained endotracheal tube, wherein the tube guiding surface of
the inferior tube guiding member extends proximally of the tube
guiding surface of the first tube guiding member. The tube guide
may further comprise a second superior tube guiding member which
has a tube guiding surface on an inferior side thereof for
contacting and thereby guiding the superior surface of a retained
endotracheal tube, wherein the second superior tube guiding member
is proximal of the first superior tube guiding member and the tube
guiding surfaces of the first and second superior tube guiding
members are spaced apart, wherein the tube guiding surface of the
second superior tube guiding member is spaced apart from and
proximal of the proximal end of the tube guiding surface of the
inferior tube guiding member, such that an endotracheal tube can be
introduced into the tube guide between the proximal end of the tube
guiding surface of the inferior tube guiding member and the distal
end of the tube guiding surface of the superior tube contacting
member at an angle to the length of the insertion section at the
proximal end of the tube guiding surface of the inferior tube
guiding member.
[0064] According to a fourth aspect of the present invention there
is provided an elongate laryngoscope insertion section having a
proximal end and a distal end for insertion into a patient's oral
cavity in use, the insertion section comprising a tube guide for
removably retaining an endotracheal tube and guiding a retained
endotracheal tube towards a patient's larynx, the tube guide
comprising a plurality of tube guiding members having tube guiding
surfaces which are arranged to contact and thereby guide the
inferior or superior surface of a retained endotracheal tube, the
plurality of tube guiding members comprising at least an inferior
tube guiding member having a tube guiding surface on a superior
side thereof for contacting and thereby guiding the inferior
surface of a retained endotracheal tube, and a first superior tube
guiding member at the distal end of the tube guide having a tube
guiding surface on an inferior side thereof for contacting and
thereby guiding the superior surface of a retained endotracheal
tube, wherein the tube guide is arranged so that, for endotracheal
tubes of a range of external diameters, a retained endotracheal
tube will be continuously curved at least from where a retained
endotracheal tube extends through a patient's teeth when the
insertion section is inserted fully into a patient to the first
superior tube guiding member.
[0065] As the tube guide is arranged to retain an endotracheal tube
such that it is curved at least from where a retained endotracheal
tube extends through a patient's teeth when the insertion section
is inserted fully into a patient to the first superior tube guiding
member, the tube will be easier to insert than would be the case if
the endotracheal tube was retained in a generally J-shaped
formation and the insertion section will be easier to insert than
if the insertion section was arranged in a generally J-shaped
formation. The tube guide may be arranged to retain the
endotracheal tube with a constant radius of curvature.
[0066] The tube guide may be arranged such that a retained
endotracheal tube has a greater curvature between where it extends
through a patient's teeth when the insertion section is inserted
fully into a patient and the first superior tube guiding member
than the curvature of the insertion section between where it
extends through a patient's teeth when the insertion section is
inserted fully into a patient and the first superior tube guiding
member.
[0067] According to a fifth aspect of the present invention there
is provided an elongate laryngoscope insertion section having a
proximal end and a distal end for insertion into a patient's oral
cavity in use, the insertion section comprising a tube guide for
removably retaining an endotracheal tube and guiding a retained
endotracheal tube towards a patient's larynx and an elongate
member, wherein the tube guide comprises a plurality of tube
guiding members which extend laterally of the elongate member
having tube guiding surfaces which are arranged to contact and
thereby guide the inferior or superior surface of a retained
endotracheal tube, the plurality of tube guiding members comprising
at least an inferior tube guiding member having a tube guiding
surface on a superior side thereof for contacting and thereby
guiding the inferior surface of a retained endotracheal tube, and a
first superior tube guiding member having a tube guiding surface on
an inferior side thereof for contacting and thereby guiding the
superior surface of a retained endotracheal tube, wherein, at at
least one location along the length of the insertion section, the
thickness of the elongate member is less than the thickness of the
adjacent tube guide.
[0068] According to a sixth aspect of the present invention there
is provided an elongate laryngoscope insertion section having a
proximal end and a distal end for insertion into a patient's oral
cavity in use, the insertion section comprising a tube guide for
removably retaining an endotracheal tube and guiding a retained
endotracheal tube towards a patient's larynx and an elongate
member, wherein the tube guide comprises a plurality of tube
guiding members which extend laterally of the elongate member and
have tube guiding surfaces which are arranged to contact and
thereby guide the inferior or superior surface of a retained
endotracheal tube, the plurality of tube guiding members comprising
at least an inferior tube guiding member having a tube guiding
surface on a superior side thereof for contacting and thereby
guiding the inferior surface of a retained endotracheal tube, and a
first superior tube guiding member having a tube guiding surface on
an inferior side thereof for contacting and thereby guiding the
superior surface of a retained endotracheal tube, wherein either or
both (i) the inferior tube guiding member extends further in an
inferior direction than the elongate member adjacent to the
inferior tube guiding member or (ii) the superior tube guiding
member extends further in a superior direction than the elongate
member adjacent to the superior tube guiding member. According to a
seventh aspect of the present invention there is provided an
elongate laryngoscope insertion section having a proximal end and a
distal end for insertion into a patient's oral cavity in use, the
insertion section comprising a tube guide for removably retaining
an endotracheal tube and guiding a retained endotracheal tube
towards a patient's larynx, wherein the tube guide is adapted to
retain endotracheal tubes with a range of external diameters within
an operating range of endotracheal tube external diameters, under
flexural tension.
[0069] Preferably, the tube guide comprises a plurality of tube
guiding members having tube guiding surfaces which are arranged to
contact and thereby guide the inferior or superior surface of a
retained endotracheal tube, the plurality of tube guiding members
comprising at least an inferior tube guiding member having a tube
guiding surface on a superior side thereof for contacting and
thereby guiding the inferior surface of a retained endotracheal
tube, a first superior tube guiding member having a tube guiding
surface on an inferior side thereof for contacting and thereby
guiding the superior surface of a retained endotracheal tube, and a
second superior tube guiding member located proximally of the first
superior tube guiding member and having a tube guiding surface on
an inferior side thereof for contacting and thereby guiding the
superior surface of a retained endotracheal tube, wherein the tube
guiding surfaces of the first and second superior tube guiding
members are spaced apart, with at least a portion of the tube
guiding surface of the inferior tube guiding member being proximal
of the proximal end of the tube guiding surface of the first
superior tube guiding member and distal of the distal end of the
tube guiding surface of the second superior tube guiding member,
wherein the tube guiding members are arranged to retain
endotracheal tubes with a range of external diameters within an
operating range of endotracheal tube external diameters under
flexural tension such that a retained endotracheal tube exerts a
force in a superior direction on the first and second superior tube
guiding members applying a force in an inferior direction and a
force in an inferior direction on the inferior tube guiding
member.
[0070] Preferably, the tube guide is arranged to that a retained
endotracheal tube can be removed laterally from the tube guide.
More preferably, the insertion section comprises an elongate member
and the tube guiding members extend laterally from the elongate
member.
[0071] According to an eighth aspect of the present invention there
is provided an elongate laryngoscope insertion section having a
proximal end and a distal end for insertion into a patient's oral
cavity in use, the insertion section comprising a tube guide for
removably retaining an endotracheal tube and guiding a retained
endotracheal tube towards a patient's larynx and an elongate
member, wherein the tube guide comprises a plurality of tube
guiding members which extend laterally of the elongate member and
have tube guiding surfaces which are arranged to contact and
thereby guide the inferior or superior surface of a retained
endotracheal tube, the plurality of tube guiding members comprising
at least an inferior tube guiding member having a tube guiding
surface on a superior side thereof for contacting and thereby
guiding the inferior surface of a retained endotracheal tube, and a
first superior tube guiding member having a tube guiding surface on
an inferior side thereof for contacting and thereby guiding the
superior surface of a retained endotracheal tube, wherein there is
at least one location, proximal of the first superior tube guiding
member, where an endotracheal tube is retained in use laterally of
the elongate member with the inferior and superior sides of the
endotracheal tube being left exposed.
[0072] According to a ninth aspect of the present invention there
is provided an elongate laryngoscope insertion section having a
proximal end and a distal end for insertion into a patient's oral
cavity in use, the insertion section comprising a tube guide for
removably retaining an endotracheal tube and guiding a retained
endotracheal tube towards a patient's larynx, wherein the insertion
section and tube guide are arranged to leave the inferior or
superior surface of a retained endotracheal tube exposed along at
least 25% and preferably 50% or more preferably 75% of the length
of the insertion section between the most proximal location where
the insertion section contacts a retained endotracheal tube and the
most distal location where the insertion section contacts a
retained endotracheal tube.
[0073] Preferably, the inferior surface of a retained endotracheal
tube is left exposed along at least 25% and preferably 50% or more
preferably 75% of the length of the insertion section between the
most proximal location where the insertion section contacts a
retained endotracheal tube and the most distal location where the
insertion section contacts a retained endotracheal tube.
[0074] Preferably, the superior surface of a retained endotracheal
tube is left exposed along at least 25% and preferably 50% or more
preferably 75% of the length of the insertion section between the
most proximal location where the insertion section contacts a
retained endotracheal tube and the most distal location where the
insertion section contacts a retained endotracheal tube.
[0075] Preferably, both the inferior and superior surface of a
retained endotracheal tube are left exposed along a continuous
region of at least 5% or preferably at least 10% of the length of
the insertion section between the most proximal location where the
insertion section contactsa retained endotracheal tube and the most
distal location where the insertion section contacts a retained
endotracheal tube. Preferably, the continuous region is located
close to the teeth of a patient of typical dimensions when the
insertion section is inserted fully into a patient in use.
[0076] Preferably, the tube guide is arranged to enable a retained
endotracheal tube to be removed laterally from the tube guide and a
retained endotracheal tube is retained with its lateral side at
least partially exposed along the entire length of the insertion
section. Preferably, the insertion section comprises an elongate
member, wherein the tube guide comprises a plurality of tube
guiding members which extend laterally of the elongate member and
have tube guiding surfaces which are arranged to contact and
thereby guide the inferior or superior surface of a retained
endotracheal tube, the plurality of tube guiding members comprising
at least a first superior tube guiding member having a tube guiding
surface on an inferior side thereof for contacting and thereby
guiding the superior surface of a retained endotracheal tube and a
second superior tube guiding member having a tube guiding surface
on an inferior side thereof for contacting and thereby guiding the
superior surface of a retained endotracheal tube, wherein the
second superior tube guiding member is located proximally of the
first superior tube guiding member and the tube guiding surfaces of
the first and second superior tube guiding members are spaced
apart, wherein the tube guiding surface of the second superior tube
guiding member is the most proximal location where the insertion
section contacts a retained endotracheal tube. The tube guiding
surface of the first superior tube guiding member is preferably the
most distal location where the insertion section contacts the
superior side of a retained endotracheal tube and the tube guiding
surface of the first superior tube guiding member may be the most
distal location where the insertion section contacts a retained
endotracheal tube.
[0077] Optional features discussed in relation to any of the first
through ninth aspects of the invention are optional features of any
of the first through ninth aspects of the invention. The invention
also extends, in a tenth aspect, to a laryngoscope comprising a
handle and an elongate insertion section according to any one of
the first nine aspects of the invention.
[0078] The insertion section may be fixedly attached to the handle.
Alternatively, the laryngoscope may comprise a body which comprises
the handle and the elongate insertion section may be detachably
retainable on the body. The insertion section may comprise an
elongate member having a bore therein and the body may comprise an
insertion section supporting member which extends into and support
the insertion section. Further optional and preferred features of
the insertion section supporting member, elongate member and bore
correspond to those discussed above in relation to the first nine
aspects of the invention.
DESCRIPTION OF THE DRAWINGS
[0079] An example embodiment of the present invention will now be
illustrated with reference to the following Figures in which:
[0080] FIG. 1 is an orthogonal view from a lateral position of a
laryngoscope insertion section according to the present
invention;
[0081] FIGS. 2 to 4 are perspective views from a range of
orientations of the laryngoscope insertion section of FIG. 1 ;
[0082] FIG. 5 is an orthogonal view from a lateral position of the
laryngoscope insertion section of FIG. 1 detachably retaining an
endotracheal tube with a diameter at the upper end of an operating
range of endotracheal tube sizes;
[0083] FIG. 6 is a series of cross-sections through the insertion
section and retained endotracheal tube of FIG. 5 along cut lines
A-A, B-B, C-C and D-D;
[0084] FIG. 7 is a series of cross-sections through an alternative
insertion section and retained endotracheal tube along cut lines
equivalent to A-A, B-B, C-C and D-D of FIG. 1;
[0085] FIG. 8 is a series of cross-sections through a further
insertion section and retained endotracheal tube along cut lines
equivalent to A-A, B-B, C-C and D-D of FIG. 1;
[0086] FIG. 9 is a series of cross-sections through a still further
insertion section and retained endotracheal tube along cut lines
equivalent to A-A, B-B, C-C and D-D of FIG. 1 ;
[0087] FIG. 10 is an orthogonal view from a lateral position of the
laryngoscope insertion section of FIG. 1 detachably retaining an
endotracheal tube with a diameter at the upper end of an operating
range of endotracheal tube sizes;
[0088] FIG. 11 is an orthogonal view from a lateral position of the
laryngoscope insertion section of FIG. 1 detachably retaining an
endotracheal tube with a diameter at the lower end of an operating
range of endotracheal tube sizes; and
[0089] FIG. 12 corresponds to FIG. 10 including indications of the
centre lines of the retained endotracheal tube and the insertion
section.
DETAILED DESCRIPTION OF AN EXAMPLE EMBODIMENT
[0090] With reference to FIGS. 1 to 5, a laryngoscope insertion
section for use with adult humans, shown generally as 1, comprises
an elongate member 2 which extends from the proximal end of the
insertion section 4 but does not extend as far as the distal end of
the insertion section 6. The elongate member has a light-permeable
viewing port 8 at its distal end. An elongate bore 10 extends along
the elongate member from the proximal end of the elongate member
for receiving and retaining an insertion section retaining
protrusion of a laryngoscope and covering the insertion section
retaining protrusion to protect it from bodily fluids in use. A
retaining portion 12, which includes a fixing aperture 14 for
engaging with a corresponding protrusion on an insertion section
supporting member of a laryngoscope, facilitates the removable
attachment of the insertion section to a laryngoscope. The
insertion section may be used with a laryngoscope including a
insertion section retaining member with a video camera and light
source which is included in the insertion section retaining member,
so that light from the light source can illuminate a patient's
trachea and the surrounding region and the video camera can relay
images of the patient's trachea and the surrounding region to a
display. A broad protrusion 16 extends from the end of the elongate
member, which functions as a blade for contacting and typically
lifting a patient's anatomy in use to provide clear access to the
larynx.
[0091] A tube guide extends laterally of the elongate member. The
tube guide comprises a distal superior tube guiding member 18,
located towards the distal end of the insertion section, which
extends from the superior side of the elongate member and functions
as the first superior tube guiding member. The inferior surface of
the distal superior tube guiding member includes a tube guiding
surface 20 which is arranged to contact and thereby guide the
superior surface of a retained endotracheal tube. A lateral edge 22
of the elongate member does not function as the tube guiding
surface as, although it may contact an endotracheal tube in use, it
does not contact and thereby guide the superior surface of a
retained endotracheal tube.
[0092] The tube guide also comprises a proximal superior tube
guiding member 24, located towards the proximal end of the
insertion section, which extends laterally from the elongate member
and functions as the second superior tube guiding member. The
inferior surface of the proximal superior tube guiding member also
includes a tube guiding surface which is arranged to contact and
thereby guide the superior surface of a retained endotracheal
tube.
[0093] The tube guiding surfaces of the proximal and distal
superior tube guiding members are generally incurvate. The proximal
and superior tube guiding members are of generally even thickness
and extend laterally and superiorly from the elongate member, from
a location on the lateral side of the elongate member which is near
to but not level with the superior surface 25 of the elongate
member. They extend superiorly to the superior surface of the
elongate member, curve over a retained endotracheal tube in use and
then curve laterally and inferiorly to extend over and guide the
superior surface of a retained endotracheal tube. The tube guiding
surface of the proximal superior tube guiding member extends
superiorly relative to the insertion section towards its distal
end. The tube guiding surface of the distal superior tube guiding
member extends inferiorly relative to the insertion section towards
its distal end. This arrangement facilitates the retention of an
endotracheal tube with a greater curvature than the insertion
section. An inferior tube guiding member 26 extends from a location
which is distal of the proximal superior tube guiding member
towards the distal end of the insertion section. The inferior tube
guiding member comprises a tube guiding surface which is arranged
to contact and thereby guide the inferior surface of a retained
endotracheal tube. The inferior tube guiding member tapers at a
proximal end and so it also comprises an inferior surface portion
28 which does not function as a tube guiding surface because it
does not contact and thereby guide the inferior surface of a
retained endotracheal tube in use. The tube guiding surfaces of the
inferior tube guiding member is also generally incurvate. The
inferior tube guiding member is of generally even thickness and
extends laterally and inferiorly from the elongate member, from a
location on the lateral edge of the elongate member which is near
to but not level with the inferior surface 25 of the elongate
member. The inferior tube guiding member extends inferiorly to the
inferior surface of the elongate member, curves over a retained
endotracheal tube in use and then curves laterally and superiorly
to extend under and guide the inferior surface of a retained
endotracheal tube.
[0094] The tube guide is arranged to leave the inferior and
superior surfaces of a retained endotracheal tube exposed along a
majority of the length of the insertion section between the most
proximal and most distal locations where the endotracheal tube
contacts a retained endotracheal tube. In an insertion section for
use with adult humans, the length of the proximal superior tube
guiding member, along its most superior region, may be
approximately 22 mm and the length of the distal superior tube
guiding member, along its most superior region, may be
approximately 15 mm. The distance between the distal end of the
proximal superior tube guiding member and the proximal end of the
distal superior tube guiding member, following the curve of the
insertion section, between the most superior regions of the
proximal and distal superior tube guiding members, may be
approximately 68 mm, or 65 mm in a direct line. The distance
between the proximal end of the inferior tube guiding member and
the distal end of the proximal superior tube guiding member may be
approximately 25 mm and the inferior tube guiding member may extend
approximately 45 mm proximally of the proximal end of the distal
superior tube guiding member.
[0095] The inferior tube guiding member and the distal superior
tube guiding member are arranged to guide a retained endotracheal
tube 29 towards a patients' trachea in use. The tube guiding
surfaces of the proximal and distal superior tube guiding members
are spaced apart because the proximal and distal superior tube
guiding members are spaced apart. The superior surface of a
retained endotracheal tube is exposed between the tube guiding
surfaces of the proximal and distal superior tube guiding members.
The inferior tube guiding member extends proximally of the distal
superior tube guiding member and so there is a region where a
retained endotracheal tube is guided on its inferior side but not
its superior side. The proximal end 30 of the tube guiding surface
inferior tube guiding member is spaced apart from the distal end 32
of the proximal superior tube guiding member, by a sufficient
distance to enable a 12.3 mm external diameter endotracheal tube
(being the upper end of an operating range of endotracheal tube
sizes) to be introduced at an angle to the centre line of the
insertion section.
[0096] FIG. 6 comprises a series of cross-sections through the
insertion section of FIG. 5 along cut lines A-A, B-B, C-C and D-D.
Note that in this arrangement the superior surface of the proximal
superior tube guiding member is substantially in line with the
superior surface of the elongate member (A-A) and the endotracheal
tube (which has a diameter of 12.3 mm) has a superior surface which
extends superiorly of the superior surface of the adjacent elongate
member (C-C). Level with the distal superior tube guiding member
(D-D), the inferior surface of the inferior tube guiding member
extends further in an inferior direction than the inferior surface
of the elongate member.
[0097] Furthermore, level with the distal superior tube guiding
member, the superior surface of the distal superior tube guiding
member extends further in a superior direction than the superior
surface of the elongate member.
[0098] FIG. 7 comprises a series of cross-sections through an
alternative insertion section along cut lines which are equivalent
to A-A, B-B 1 C-C and D-D. In this embodiment, the inferior tube
guiding member is not incurvate but has an inferior surface which
is level with the inferior surface of the elongate member and the
superior surface of the distal superior tube guiding member extends
superiorly of the superior surface of the elongate member. The
superior surface of the proximal superior tube guiding member
extends further in a superior direction than the superior surface
of the elongate member (A-A). At the proximal end of the inferior
tube guiding member, the inferior surface of the a retained
endotracheal tube with 12.3 mm diameter extends further in an
inferior direction than the inferior surface of the elongate
member. Further along the inferior tube guiding member, the
inferior surface of the inferior tube guiding member extends
inferiorly of the inferior surface of the elongate member.
[0099] FIG. 8 comprises a series of cross-sections through an
alternative insertion section along cut lines which are equivalent
to A-A, B-B, C-C and D-D. In this embodiment, no proximal superior
tube guiding member is provided (A-A). The inferior tube guiding
member extends further inferiorly than in the previous embodiments
to facilitate smooth insertion of the tube when it is pushed along
its length by an intubator (C-C). The lateral surface of the
elongate member comprises a slight elongate groove (B-B) to better
retain an endotracheal tube within the tube guide. Level with the
proximal half of the distal superior tube guiding member (C-C), the
inferior surface of the inferior tube guiding member extends
further in an inferior direction than the inferior surface of the
elongate member. Furthermore, level with the proximal half distal
superior tube guiding member, the superior surface of the distal
superior tube guiding member extends further in a superior
direction than the superior surface of the elongate member. The
superior tube guiding member extends distally of the inferior tube
guiding member as illustrated at cross-section D-D.
[0100] The various cross-sections illustrated in FIGS. 6 to 8 may
be combined in any combination to form a range of insertion
sections.
[0101] FIG. 9 comprises a series of cross-sections through a still
further alternative insertion section along cut lines which are
equivalent to A-A, B-B, C-C and D-D. In this embodiment, which has
especially reduced bulk, the elongate member is narrower and the
tube guiding members extend significantly further in an inferior or
superior direction, as appropriate, than the adjacent corresponding
surface of the elongate member. At cross section B-B, the retained
12.3 mm endotracheal tube extends superiorly and inferiorly of the
superior and inferior surfaces of the elongate member respectively.
Accordingly, there is a region of insertion section, between the
proximal distal superior tube guiding member and the proximal end
of the tube guiding surface of the inferior tube guiding member
where the thickness of the insertion section is less than the
thickness of the adjacent 12.3 mm endotracheal tube. At this
location, and proximal of the proximal superior tube guiding member
the thickness of the elongate member may be less than 8 mm and
perhaps as thin as 3 mm or 4 mm.
[0102] The insertion section is typically moulded in one piece from
a transparent plastics material and supplied sterilised within a
sealed package.
[0103] In use, the insertion section is detachably mounted on an
elongate insertion section supporting member (not shown) which fits
snugly within the bore. The elongate insertion section supporting
member is typically attached to the handle of a laryngoscope body.
A video camera, functioning as imaging apparatus and a light
emitting diode, functioning as light source, are located on the
distal tip of the elongate insertion section supporting member,
such that they are adjacent to the window in use. Electric wires
run down the length of the elongate insertion section supporting
member which supply power to the video camera and light source.
[0104] The elongate strengthening section is typically fabricated
from steel or another rigid material. As well as supporting the
video camera and light source and enclosing the electrical
connections to the video camera and light source, the elongate
strengthening section functions to provide support the insertion
section, enabling it to be thinner than would otherwise be the
case.
[0105] Once the insertion section has been attached to a
laryngoscope body, an endotracheal tube within an operating range
of endotracheal tube sizes which can be used reliably with the
insertion section is inserted into the tube guide, in contact with
the tube guiding surfaces of the inferior tube guiding member and
the proximal and distal tube guiding members. For an insertion
section for use in the intubation of human adults, a suitable
operating range of external tube diameters would be 8 mm to 12.3
mm.
[0106] The laryngoscope with insertion section is then introduced
into a patient, the blade is used to contact, and perhaps lift, the
patient's anatomy to obtain clear access to the larynx. The light
emitting diode illuminates the patient's laryngeal area whilst
images from the video camera are relayed to a display which might
be an integral part of the laryngoscope or may be separate to the
laryngoscope. The laryngoscope is inserted fully into a patient,
i.e. to the point where an anaesthetist would consider it to be
optimally aligned for the introduction of an endotracheal tube. The
endotracheal tube is then advanced forward through the insertion
section into the patient's larynx. Once the tube has been
successfully inserted, it can be detached laterally from the
insertion section and separated from the insertion section in situ.
The insertion section can then be removed and the endotracheal tube
left in place.
[0107] Note that endotracheal tubes will be retained within the
tube guide under flexural tension. Although endotracheal tubes
typically have an inherent curvature, the retained endotracheal
tubes will be subject to bending forces in the inferior direction
at both the proximal and distal superior tube guiding member and a
force in the superior direction at at least a portion of the
inferior tube guiding member. Endotracheal tubes are resilient and
so they exert a force 42 in a superior direction on at least the
distal ends of the proximal and distal superior tube guiding
members and a further force 44 in an inferior direction on at least
a region of (typically towards or at the proximal end) the inferior
tube guiding member. This improves the grip of the tube guiding
members on a retained endotracheal tube enabling the tube guiding
members to have lower profiles and to extend less far around
retained endotracheal tubes than would otherwise be the case,
facilitating the provision of a reliable laterally opening tube
guide.
[0108] In practice, retained endotracheal tubes of at least some
diameters (typically at the upper end of the operating range of
endotracheal tube sizes) will typically contact the tube guiding
surface of the proximal and distal superior tube guiding members
only at the distal ends of these tube guiding members, due to the
curved path of the retained tube, whilst the endotracheal tube is
at rest within the guide. Other tube guiding surfaces of the
proximal and distal superior tube guiding members are relevant
during the stage of inserting an endotracheal tube into the tube
guide, although they could conceivably be omitted. Similarly, such
endotracheal tubes will typically only contact the tube guiding
surface of the inferior tube guiding member towards the proximal
end of the tube guiding surface, again due to the curved path of
the retained endotracheal tube. This arrangement, in which the
endotracheal tubes only contact a limited region of some or all of
the tube guiding members reduces friction when the endotracheal
tube is advanced into a patient's trachea.
[0109] The insertion section has a number of key advantages which
result from features of the design. Firstly, the insertion section
is adapted to minimise the risk of damaging a patient's teeth and
to facilitate the manoeuvrability of the insertion section in the
region of a patient's teeth as there is a substantial narrow region
34, functioning as the first region, where the thickness of the
insertion section is less than the external diameter of the largest
size of endotracheal tube in an operating range of endotracheal
tubes (12.3 mm in this example) plus the thickness of the inferior
tube contacting member where it contacts the inferior surface of a
retained endotracheal tube (at least 0.75 mm and typically 1.5 mm)
plus the thickness of the distal superior tube contacting member
where it contacts the superior surface of a retained endotracheal
tube (at least 0.75 mm and typically 1.5 mm). Although the narrow
region extends along the majority of the length of the insertion
section in this example, it would be useful to provide a narrow
section with a thickness which is less than the abovementioned
thickness, even if it only extended along a short portion of the
insertion section, such as along a length of 2 cm, 1 cm or even 0.5
cm of the insertion section, close to a patient's teeth when the
insertion section is fully inserted into a patient of typical
dimensions.
[0110] One feature which enables the thickness of the tube guide to
remain less than the said thickness (15.3 mm in the present
example) proximal of the distal superior tube contacting member is
the arrangement in which the tube guiding surfaces of the proximal
and distal superior tube contacting members are spaced apart,
leaving the superior surface of a retained endotracheal tube
exposed. The presence of an inferior tube guiding member and a
distal superior tube guiding member is sufficient to guide the
tube. However, the arrangement in which the inferior tube guiding
member extends proximally of the tube guiding surface of the distal
superior tube guiding member and there is a region where the
superior surface of a retained tube is left exposed opposite a
first region of tube guiding surface of the inferior tube guiding
member, has the benefit that a retained tube can be accurately
guided by the inferior tube guiding member but the bulk of the
insertion section is reduced by the omission of the a tube guiding
member opposite the said region of the inferior tube guiding
member.
[0111] Similarly, as no tube guiding surface is provided opposite
the tube guiding surface of the proximal superior tube guiding
member, the thickness of the tube guide remains less than the said
thickness (15.3 mm in the present example) close to a patient's
teeth in use. There is a region between the distal end of the tube
guiding surface of the proximal superior tube guiding member and
the proximal end of the tube guiding surface of the inferior tube
guiding member where a retained endotracheal tube is exposed on
both its inferior and superior surfaces. This is advantageous
firstly in that the overall bulk of the insertion section has been
reduced by omitting tube guiding members in this region. This
enables the inferior tube guiding member and a projection of the
superior tube guiding member to be spaced apart by less than the
external diameter of an endotracheal tube at the top end of an
operating range of tube sizes (12.3 mm external diameter in the
present example).
[0112] Furthermore, this arrangement facilitates the introduction
of an endotracheal tube at the top end of an operating range of
tube sizes at an angle to the length of the insertion section. This
is best illustrated in FIG. 12 where it will be seen that the
centre line 36 of the retained 12.3 mm endotracheal tube has a
greater radius of curvature than the centre line of the insertion
section 38 and, indeed, the most superior point on the retained
endotracheal tube is superior of the superior surface of the
insertion section. Thus, the endotracheal tube extends into the
volume which would be occupied by a superior tube guiding member if
the superior tube guiding member had extended to the proximal end
of the inferior tube guiding member. Accordingly, the insertion
section is thinner from the proximal superior tube guiding member
to the distal superior tube guiding member than would have been the
case if the tube guide covered both the inferior and superior
surface of a retained endotracheal tube along this length. An
endotracheal tube at the bottom end of the operating range of
endotracheal tube sizes might alternatively have a smaller radius
of curvature and may not contact the inferior tube guiding
member.
[0113] It is also notable that the thickness of the tube guide is
greater level with the distal superior tube guiding member than the
thickness of the adjacent elongate member. Furthermore, the
superior surface of the distal superior tube guiding member extends
further in a superior direction than the superior surface of the
adjacent elongate member and the inferior surface of the inferior
tube guiding member extends further in an inferior direction than
the inferior surface of the elongate member adjacent to the
inferior tube guiding member. Accordingly, the overall bulk of the
insertion section is less than would be the case if the inferior
and superior surfaces of the tube guiding members extended level
with the inferior and superior surfaces respectively of the
elongate member, along the entire length of the insertion section.
This substantially reduces the overall bulk of the insertion
section, facilitating rapid intubation.
[0114] The maintenance of a retained endotracheal tube in a curved
path is facilitated by the provision of a distal superior tube
contacting member which has an inferior tube guiding surface which
is at an angle to the centre line of the insertion section, such
that it extends inferiorly towards its distal end. Similarly, the
proximal superior tube contacting member has an inferior tube
guiding surface which is at an angle to the centre line of the
insertion section, such that it extends superiorly towards its
distal end.
[0115] In some embodiments, illustrated in FIG. 7, the superior
surface of the proximal superior tube guiding member extends
further in a superior direction than the superior surface of the
elongate member adjacent to the proximal superior tube guiding
member which reduces the bulk of the insertion section in the
region of a patient's teeth when the insertion section is fully
inserted into a patient's oral cavity.
[0116] In some embodiments, illustrated in FIG. 8, the proximal
superior tube guiding member is entirely omitted. The tube guiding
surface of the inferior tube guiding member does not extend to the
proximal end of the insertion section. This reduces bulk further
and is facilitated by the provision of an inferior tube guiding
member having a tube guiding surface which does extend proximally
of the proximal end of the tube guiding surface of the distal
superior tube guiding member. In some embodiments, the tube guiding
surface of the distal superior tube guiding member is entirely
distal of the portion of the insertion section (which is typically
the most curved) which extend around the base of a patient's tongue
in use. However, in the embodiment illustrated in FIG. 8, the tube
guiding surface of the distal superior tube contacting member does
extend to the portion of the insertion section which extends around
the base of a patient's tongue in use. In the embodiment of FIG. 9,
the thickness of the elongate member is significantly reduced, to
less than the external diameter of the largest endotracheal tube in
the operating range of endotracheal tubes, to further reduce the
overall bulk of the insertion section.
[0117] A further benefit of arranging the tube guide such that a
retained endotracheal tube remains curved between the proximal end
of the insertion section and the distal superior tube guiding
member is that, in contrast to J-shaped insertion sections with
tube guides, the insertion section can be more naturally introduced
into a patient's oral cavity along a curved path. In contrast,
J-shaped insertion sections require to be tilted backwards and
forward as they inserted in a multi-stage process. Furthermore less
force would be required to advance the retained tube into a
patient's trachea than with a J-shaped tube guide, where
significant force would be exerted on the tube guide where the
straight portion began to curve. Endotracheal tubes are typically
slightly curved and this arrangement facilitates convenient use of
slightly curved endotracheal tubes. As a result of the design
features which reduce the overall bulk of the insertion section,
the insertion section can be made of a size to work with larger
diameter endotracheal tubes. For example, an insertion section
which can be easily used for rapid insertion of a tube in difficult
intubation situations can be provided which can be used with
endotracheal tubes with a diameter of up to 12.3 mm.
[0118] Alternative insertion sections may be provided for use with
infant humans, or specific animals or groups of animals, such as
horses. In this case, the insertion section may be scaled
proportionately. The length, width and thickness of the insertion
section as a whole are typically scaled proportionately.
Nevertheless, some dimensions, such as the thickness of the tube
guiding members, may not be scaled proportionately. It will be seen
that the tube guide has been arranged to retain an endotracheal
tube laterally of the elongate member, fitting better with the
general shape of a patient's oral cavity than a tube guide which
retain an endotracheal tube inferiorly or superiorly of the
insertion section.
[0119] Although the illustrated embodiments show proximal and
distal superior tube guiding members which finish abruptly so that
the tube guiding surfaces of the proximal and distal superior tube
guiding members terminate at the proximal and distal ends of each
superior tube guiding member, either or both of the proximal and
distal superior tube guiding members could instead taper and
include portions which did not function as tube guiding surfaces
which contact and thereby guide the superior surface of a retained
endotracheal tube. For example, a lip extending from the elongate
member may connect the proximal and distal superior tube guiding
members, but not affect the function of the invention because the
lip does not constitute a tube guiding surface within the meaning
of the present invention.
[0120] Although the invention has been illustrated using a
detachably retainable insertion section portion, the insertion
section may alternatively be an integral part of a laryngoscope.
Further modifications and variations may be made within the scope
of the invention herein disclosed.
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